6260 Week 4 Practice Questions

How many hours/day should a patient with scoliosis wear their bracee?

18 hours

A patient is born with spina bifida, a neural tube defect. The nurse understands that this defect occurred during what week of gestation?

4th week of gestation The 4th week of gestation is the stage in which the neural tube closes. Lack of maternal folic acid during first 28 days of gestation is considered a teratogenic cause of spinal cord malformations.

The nurse receives a report on multiple patients newly admitted to the pediatric unit. Which patient should the nurse assess first?

6-month-old with a fractured left femur Fractures in children younger than 1 year are unusual and may indicate child abuse; the nurse should assess this child first to evaluate the family situation.

The nurse cares for a child with rapidly progressing paralysis due to Guillain-Barré syndrome (GBS). After supportive care fails, the nurse anticipates what treatment as the next step in this patient's care?

Administer IV immunoglobulin A child with rapidly progressing paralysis due to Guillain-Barré syndrome should be given high-dose IVIG. The IV immunoglobulin interferes with autoantibodies causing GBS and helps restore function in the patient.

Match the cerebral palsy (CP) symptoms to the nursing intervention for the hospitalized pediatric patient: Involuntary movement

Administer a benzodiazepine

The nurse is caring for a pediatric patient admitted with seizure activity related to cerebral palsy (CP). Which interventions should the nurse perform immediately?

Administer intravenous diazepam (Valium). Administering a benzodiazepine will decrease spasticity and seizure activity. This is an immediate need. Institute safety measures such as seizure padding. Safety is a primary goal, and the nurse must prevent the child from sustaining unnecessary injuries.

Match the musculoskeletal diagnostic procedure with the appropriate nursing consideration: Arthroscopy

Administer prophylactic antibiotics

A child is brought to the emergency department with a suspected spinal cord injury at the level of C2. What is the immediate priority in the nursing care of a patient with this injury?

Administer ventilatory support A spinal cord injury at the level of C2 will cause the patient to be apneic and require ventilator support which is the immediate priority in the nursing care plan in this patient.

The nurse is performing a neurologic assessment on a patient with cerebral palsy (CP). The nurse notes bilateral arm spasticity and the child is unable to grip the nurse's fingers. What action should the nurse perform?

Complete neurologic assessment Spasticity is an expected finding in a child with cerebral palsy. The nurse should continue the assessment.

Match the meningeal layers and structures with the appropriate description: Dura

Composed of two meningeal layers

Match each component of the musculoskeletal system with the connecting tissue that helps it to function: Ligaments

Connect bone to bone

Match each component of the musculoskeletal system with the connecting tissue that helps it to function: Tendons

Connect muscle to bone

What are the priorities when developing a nursing plan of care for a ten-year-old patient with Guillain-Barré syndrome (GBS)?

Determine bilateral lower extremity strength. Neuromuscular impairment can be a finding in patients affected by Guillain-Barré. Assessing the patient's lower extremity strength will therefore be a priority. Check vital signs and trends every four hours. Autonomic instability may cause dizziness or the inability to alter heart rate and is a priority when developing a nursing care plan for a patient with Guillain-Barré syndrome. Perform tests of lower and upper sensory function. Guillain-Barré syndrome often presents with limb paresthesia, which is defined as altered sensation from the patient's limbs. This will be a priority in developing a care plan for this patient. Observe chewing and swallowing of solids and liquids. The patient with Guillain-Barré syndrome may develop cranial nerve dysfunction that could inhibit the ability to swallow. This will therefore be a priority in developing a nursing care plan for the patient. Evaluate respiratory rate and use of accessory muscles. The phrenic nerve may be affected in a patient with Guillain-Barré syndrome resulting in respiratory failure of the patient. Evaluating respiratory status will be a priority in caring for this patient.

The thirteen-month-old child had prenatal microsurgery for a myelomeningocele. Which assessment finding indicates the surgery was not completely successful?

Increased head circumference Increased head circumference can indicate hydrocephalus which results from the myelomeningocele complications, meaning the surgery was not completely successful in repairing the neural tube defect.

A patient presents with Guillain-Barré syndrome (GBS). What does the nurse anticipate finding in the history and physical?

Influenza vaccine received one month ago The flu shot has been demonstrated to have a link to the autoimmune process triggered in Guillain-Barré. Upper respiratory infection two weeks ago Upper respiratory infection has been associated with the subsequent development of Guillain-Barré syndrome.

A child is rushed to the emergency department following a collision on the school yard impacting the left side of the head. The nurse expects which physical finding associated with this injury?

Left arm weakness In a contrecoup injury, the weakness will occur ipsilateral to the side of injury because of the rebound of the brain within the skull. Normally an injury to the left side of the head would impact function on the right side of the body.

During the musculoskeletal assessment of a pediatric patient, the child complains of pain at the elbow when the nurse passively pronates the left radius/ulna. Which diagnostic test would the nurse expect the provider to order?

Magnetic resonance imaging The child is complaining of joint pain with movement; the nurse would anticipate magnetic resonance imaging (MRI) being used to assess for soft tissue damage, including bones, ligaments, and joints.

The nurse performs a developmental assessment of a nine-month-old infant. Which finding causes the nurse to be concerned that myelinization of the neurons is impaired?

The child is unable to transfer an object from one hand to the other hand. The myelinization of the neurons allows for effective transmission of neural signals required for proper coordination of movements. The ability to coordinate movement of the hands to move an object is a 9-month developmental milestone.

Which diagnostic tool would be used to confirm scoliosis?

X-ray

Which statements describe functions of the musculoskeletal system?

allows movement Providing movement is a function of the musculoskeletal system. Protects the heart Protecting vital organs, including the heart, is a function of the musculoskeletal system. Provides a skeletal framework Providing a skeletal framework to support the body is a function of the musculoskeletal system.

A nurse assesses the growth of a 1-month-old infant and prepares to measure the head circumference and assess the fontanels. The nurse knows that which aspect(s) of this infant's head anatomy should be an expected finding?

Presence of a posterior fontanel The posterior fontanel should be present in a 1-month-old infant because it normally closes at 2-months of age. Presence of an anterior fontanel The anterior fontanel should be present in a 1-month-old infant. This fontanel does not close until 18 months of age.

Match the cerebral palsy (CP) symptoms to the nursing intervention for the hospitalized pediatric patient: Visible tremors

Provide guided imagery

An infant was brought to the emergency department (ED) after falling from a high chair, sustaining a basilar skull fracture. Which concerning assessment findings does the nurse expect?

Clear drainage from the ear A basilar skull fracture is characterized with a patient who exhibits raccoon eyes, otorrhea, and hemotympanum.

What is NOT an objective finding in a physical assessment of a scoliosis patient?

Hump at back of neck

The nurse teaches a patient about brain structure and function. Which statement by the nurse is true regarding the child's brain anatomy and physiology?

"Cerebral spinal fluid reduces injury to the brain in the case of a fall." One of the functions of CSF is to reduce trauma to the brain by providing a cushion.

During a well-child visit, a three-year-old patient being examined exhibits unsteady gait and poorly developed speech. The health care provider suspects cerebral palsy (CP). How should the nurse guide the parents?

"Ensure that your home is free of sharp edges to protect the child in case of falling while walking." A three-year-old child with suspected cerebral palsy would be expected to have unsteadiness when walking due to abnormal development of the motor system. "The speech-language pathologist will work with you to evaluate reasons for the poorly developed speech." A three-year-old child with suspected cerebral palsy would be expected to have speech difficulties due to abnormal central nervous system development. Speech development can also be related to cognitive issues, autism, and hearing loss. "The physical therapist will show you some exercises to improve coordination and strengthen the child's muscles." Physical therapy and occupational therapy will work with the child to further evaluate gait and develop a plan to prevent or reduce declining strength and coordination.

The nurse is providing education to a child and family during a sports physical examination to explain the differences in the pediatric musculoskeletal system compared to adults. Which statement by the child indicates correct understanding of the education?

"I am not as likely to sprain my ankle when playing sports, but I should be careful." This statement indicates correct understanding of the differences between the pediatric and adult musculoskeletal system, because the resiliency of soft tissues makes sprain less likely than in adults.

A child has recently been diagnosed with Guillain- Barré syndrome. Which patient statements require follow-up by the nurse?

"I had a nasty cold two weeks ago, but mom said it was not a big deal." Enterovirus causes cold and flu-type symptoms and is associated with the development of Guillain- Barré syndrome. The child needs teaching about hand-washing techniques to prevent respiratory illnesses. "I had a red rash a while back with a fever. It only lasted about three days." A rubella infection has been associated with Guillain-Barré syndrome. The nurse follows up as the health care team works to determine a cause that could be prevented in the future. Also, if "a while back" means more than a month or so, the health care provider can rule it out as a cause. "I hate getting the flu-shot, but dad insisted this year since I've been sick so much." The influenza vaccine has a demonstrated link to the onset of Guillain-Barré. If this is the suspected cause, the child needs to avoid the flu-vaccine in the future.

Which statement by the nurse can explain the normal function of joints in the pediatric patient?

"Joints help your bones move." Many joints function to allow movement of bones.

The nurse is discussing the surgical closure of a myelomeningocele with the parents of a newborn patient. Which statement by the parents indicates the need for further teaching?

"Surgically closing this defect will ensure my baby can walk at the right age." Surgery will decrease cord deterioration and allow for earlier physical therapy and developmental interventions. The child with spina bifida corrected by surgery still may require additional surgeries.

The nurse cares for a five-year-old patient involved in a motor vehicle accident. The paralysis extends from the naval downward. In performing discharge teaching, the nurse knows further teaching is needed when the parents make which statements?

"We need to catheterize him every 8 hours for urine." The child should not hold urine in his bladder for an extended period of time. Since the child cannot feel the urge to urinate, catheterization does need to occur on a schedule. If urine is left in the bladder, causing bladder distention, a kidney infection may result. Catheterization should occur instead every 4-6 hours. "We need to make sure he has a bowel movement often." The parents need to make sure that the child has a bowel movement every 1-2 days, rather than stating "often." The stool should be softly formed rather than hard or loose. With little innervation to the bowels, peristalsis will be limited and constipation quickly becomes an obstruction. "He will need to eat every meal that we prepare for him." This is not the best way to make sure the child gets adequate nutrition. Five-year-olds normally ingest small portions and they can love a food one day and hate it the next. Nutritional teaching includes information about snacks, supplements, and nutrient-dense foods. "He will enjoy sitting outside all morning in his wheelchair." The child should not sit up in the wheelchair for an extended period of time. This statement needs to be clarified. Sitting for more than an hour or two can produce pressure ulcers.

The nurse is providing education to the parents of a child experiencing spinal shock after a spinal cord injury. Which statements by the nurse are correct?

"We will not know what permanent injuries exist for one to two months." The injuries associated with spinal shock can cause temporary loss of function, which means regaining function can occur. This statement could therefore be used by the nurse to address concerns regarding the recovery phase. "Currently, the child appears to have no function below the level of injury." Spinal shock can cause deceased function of everything below the level of injury including musculoskeletal abilities, bladder and bowel control, and so on. When the shock resolves, some function may return. "Some complications, such as low blood pressure, will resolve within a few weeks." Complications related to spinal shock, such as inability to maintain blood pressure, control temperature, and manage heart rate should resolve when the spinal shock resolves, and therefore this information can be relayed to the parents.

The nurse is caring for a child who has sustained an acceleration-deceleration head injury. Which actions should the nurse take in assessing this patient?

Assess child for retinal injury. An acceleration-deceleration head injury occurs with "shaken baby" syndrome, which is associated with retinal tears and hemorrhaging. This child will need to be assessed for retinal damage. Check child for burns and bruising. Acceleration-deceleration injuries are associated with child abuse, and so checking for other signs of abuse will be necessary. Assess for associated extremity sprain. Extremity sprains are not an associated condition occurring with acceleration-deceleration head injuries. They may however exist separately if child has been abused. Contact health care provider because child needs head computed tomography (CT). The child has suffered from an acceleration-deceleration head injury and may have an epidural hematoma that will need to be diagnosed by a head CT scan.

The nurse assesses a pediatric patient and finds deficits in speech. What additional assessment does the nurse perform to gather more data about the patient's speech deficit?

Assess for drowsiness and jitteriness. As part of Glasgow coma scale, the nurse will first assess if child's cognition is intact before assessing other reasons for speech deficit. If GCS is low, patient may require immediate intervention. Evaluate for hearing loss and deafness. Once GCS is determined to be adequate, nurse can assess for other issues such as hearing impairment. Determine if oral-motor weakness is present. Occasionally, there will be a muscular weakness or a nerve not functioning properly that can cause a speech deficit. Observe interactions between child and parents. A complete assessment of speech dysfunction will include listening to and observing interactions. This may be a clue to many issues that could cause speech deficit, including autism.

A newborn infant presents to the emergency department with papilledema. Which assessment does the nurse perform first?

Assess for patent fontanels. Infants typically do not experience papilledema because the patent fontanels allow for increased intracranial pressure; whereas, an older child or adult has no fontanels and can exhibit papilledema in reaction to increased intracranial pressure (ICP). Papilledema in infants can be a sign of immature closure of the fontanelles.

Match the musculoskeletal diagnostic procedure with the appropriate nursing consideration: Magnetic Resonance Imaging (MRI)

Assess for presence of prothesis or other metal

Which intracranial regulation processes would lead the body to compensate with hyperventilation?

Autoregulation A patient may hyperventilate as a compensatory response to elevated PaCO2 Cerebral vasodilation Elevated PaCO2 leads to cerebral vasodilation and increased cerebral blood flow. To compensate, the body may hyperventilate to "blow off" the CO2, leading to vasoconstriction and decreased cerebral blood flow. Increased cerebral blood flow Elevated PaCO2 leads to cerebral vasodilation and increased cerebral blood flow. To compensate, the body may hyperventilate to "blow off" the CO2, leading to vasoconstriction and decreased cerebral blood flow.

Match the meningeal layers and structures with the appropriate description: Arachnoid

Avascular, serous membrane

When caring for a fourteen-year-old child with traumatic brain injury, which complications must be addressed immediately?

Blood pressure 80/40 mm Hg The care for a child with traumatic brain injury includes aggressively managing hypotension of the patient because the injury could affect centers of the brain that control basic body functions such as vascular tension. Weak deep tendon reflex responses Weak deep tendon reflexes are concerning for syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and for progressive increased intracranial pressure (ICP). Oxygen saturation of 88% on room air The care for a child with traumatic brain injury includes monitoring for and correcting hypoxemia of the patient that could develop because centers of the brain that control basic body functions such as breathing are altered. Respiratory rate of 8 breaths per minute The care plan for a child with traumatic brain injury includes monitoring for hypoventilation of the patient because the injury could affect the centers of the brain that control basic body functions such as breathing.

The nurse observes that the ten-year-old patient is becoming increasingly restless. Knowing that the child suffered a concussion playing football, what does the nurse do next?

Calculate Glasgow coma score. The child's GCS will offer information about the increased restlessness and whether it is neurologic in nature. Perform bilateral pupil examination. The nurse assesses reasons for restlessness including signs of increased ICP: diplopia, papilledema, and poor pupillary response to light. Ask patient about nausea and headache. Nausea and headaches are common, early signs of increased intracranial pressure. If patient does have these, it helps direct the nurse's assessment. Check vital signs and oxygen saturation. Hypoxia can be a cause of restlessness in any population. Anytime there is a new finding in a patient, vital signs should be reevaluated as indicators of overall cardiorespiratory status.

Match the bone with the appropriate classification: Short bones

Carpals

Match the musculoskeletal diagnostic procedure with the appropriate nursing consideration: Arthrography

Check for allergy to iodine

The nurse assesses a two-year-old child with papilledema related to hydrocephalus. Which finding causes the nurse the most concern?

Child has an increased head circumference Sutures and fontanels close by 18 months of age. If sutures and fontanels are closed, child should not have an enlarged head circumference. This finding indicates there is an additional problem that would be most concerning to the nurse.

A 5-year-old child is admitted with complications related to an Arnold-Chiari malformation and myelomeningocele. What assessment findings cause the nurse to be concerned?

Child is experiencing severe headache. Arnold-Chiari can result in hydrocephalus. A headache may indicate increasing ICP. If the child has a shunt, this may indicate a malfunction.

An infant is brought to the emergency department with retinal hemorrhages, increased irritability, and a burn mark on the arm. Once stabilized, what is the nurse's priority intervention for this patient?

Consult with child protective services. Abusive head trauma or "shaken baby" syndrome is the most likely condition in an infant with retinal hemorrhages. The child should not go home with the parents until the cause of the traumatic brain injury is determined. If parents are not charged with abuse, someone must still make sure safeties are in place so consultation with child protective services is a priority intervention.

Match the cerebral palsy (CP) symptoms to the nursing intervention for the hospitalized pediatric patient: Tense muscles

Continue to monitor

Match each component of the musculoskeletal system with the connecting tissue that helps it to function: Skeletal muscles

Contractile structure

Which is the main action involved in the movement of muscle?

Contraction Movement of the skeletal muscles are produced by contraction of the elongated fibers.

Which structure is most likely to be disrupted if the left cerebral hemisphere is pushed across the cranium toward the right cerebral hemisphere?

Corpus callosum The corpus callosum is a band of commissural fibers that connects the right and left cerebral hemispheres and is the most likely to be damaged when the left cerebral hemisphere is pushed toward the right cerebral hemisphere (herniation).

Identify the lab test that would best indicate muscle damage.

Creatine phosphokinase (CPK) CPK is found in heart and skeletal muscle. Specific forms of CPK can be tested to determine what muscle type is damaged.

Match the musculoskeletal diagnostic procedure with the appropriate nursing consideration: Radionuclide Scintigraphy (Bone Scan)

Encourage fluids prior to procedure

The nurse is caring for a pediatric patient with abnormal laboratory values for rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Which assessment findings correspond with the abnormal laboratory results?

Enlarged knee joints Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and enlarged joints are a symptom of arthritis. Limping when walking Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and limping when walking is a symptom of arthritis. Pain when moving joints Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and pain when moving joints is a symptom of arthritis.

The nurse is performing the initial assessment of a 6-year-old pediatric patient. Which components of the nursing process should be included in the musculoskeletal assessment?

Evaluating motor development Evaluating the motor developmental milestones of children is a critical component of the musculoskeletal assessment to evaluate for potential musculoskeletal disorders. Checking proper movement of the eyes Movement of the eyes would be part of the eye evaluation when assessing extraocular muscle movement. Plotting the child's height on a growth chart Plotting the child's height on a growth chart is a critical component of the musculoskeletal assessment to evaluate for variations in height. Comparing child's current weight to previous results Comparing the child's current weight to previous results is a critical component of the musculoskeletal assessment to evaluate for variations in weight that could impact the musculoskeletal system.

True or False Cerebral palsy gets worse over a child's lifetime.

False

True or False Children with casts are not at risk for compartment syndrome

False

True or False A child who has just had a VP shunt placed may move their head of bed at any angle.

False

True or False There is only one kind of seizure in children.

False

Match the bone with the appropriate classification: Long bones

Femur

Which assessment findings indicate appropriate development of the musculoskeletal system of a 5-year-old patient?

Fused cranial sutures Fused cranial sutures are normal by the time the child is 12-18 months old and is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Smaller muscular size Muscles grow in size as the child ages; smaller muscle size is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Normal curvature of the neck Cervical curvature develops in the first few months of life; normal cervical curvature is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Incomplete lumbar curvature of the spine Lumbar curvature may not be fully developed until age 8-10 years; incomplete lumbar curvature is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient.

The nurse is assessing a newborn patient. Which musculoskeletal finding is most concerning?

Fused cranial sutures Infants are born with open sutures that allow for growth of the brain; fused cranial sutures at birth would be the most concerning finding in a newborn.

Which focused assessment should the nurse use to evaluate a child's motor coordination?

Gait analysis The analysis of a child's gait should be used to evaluate motor skills because the ability to walk is a complex skill and involves the motor system. Manual dexterity Assessing manual dexterity of a child such as ability to use a pencil can be used to evaluate motor skills because it evaluates fine motor skills and is a measure of myelinization. Muscle development The muscular development of a child is part of the focused assessment used to evaluate motor skills because poor muscle development will impede child's motor skill development.

A child falls from a two-story building and presents to the emergency department appearing drowsy. Which assessment should be performed by the nurse first?

Glasgow coma scale The Glasgow coma scale should be used to assess a child's level of consciousness and indicate next steps for evaluation and treatment.

A twelve-year-old child has begun experiencing difficulty in playing at recess and states, "I just can't run as fast or throw and catch the ball like I could before, so I just don't play now." On what should the nurse focus the neurologic assessment?

Gross and fine motor skills Movement and coordination must be assessed. The nurse should suspect that the child's gross and fine motor skills are underdeveloped or regressing due to lack of myelin. A decrease in myelinization slows the action potentials of the central nervous system (CNS) and therefore prevents coordination of the movement of motor units. In adults, myelin naturally regresses in the elderly. In children, myelin should increase along with motor skills.

The nurse is performing a musculoskeletal examination of a pediatric patient. Which findings indicate normal function?

Hip rotation without resistance Joints, such as the hip, enable movement and indicate normal function of the musculoskeletal system. Unrestricted range of motion in the ball and socket joints Ball and socket joints should have near 360 degrees of movement; this would be a normal finding.

In a child with a complete spinal cord injury at T6, which interventions should the nurse implement to prevent complications?

Maintain patient's bed position at 45-degree angle. Angling the bed at 45 degrees promotes venous blood return, decreased intracranial pressure (ICP), and keeping child's head midline. Notify health care provider for BP of 162/89 mm Hg. The onset of autonomic dysreflexia in child with a complete spinal cord injury at T6 includes sudden increase in systolic blood pressure. Urgent intervention will be needed.

The nurse is performing a musculoskeletal assessment on a pediatric patient. Which action is the most appropriate?

Measure the child's height Measuring the child's height should be done at every well-check visit and is the most appropriate intervention to assess for potential musculoskeletal disorders by comparing height measurements over time.

The nurse is caring for a child with a spinal cord injury. Which intervention is a priority?

Monitor the patient's temperature and skin changes. A spinal cord injury can disrupt the patient's sympathetic nervous system which controls dermal vasodilation. Hyper or hypothermia causes increased stress on the healing of the neurologic system, and monitoring temperature and skin changes will be a priority.

A 3-year-old patient is diagnosed with hydrocephalus. A ventricular shunt was placed to relieve the pressure. What is the nursing care priority for a patient who had a ventricular shunt put into place?

Monitoring for fluid leaking from the incision The main priority in the nursing care of a patient who had a ventricular shunt placed is the prevention or early detection of shunt infection, malformation, and malfunction. A leaking incision presents a high risk of infection.

The patient is diagnosed with Guillain-Barré syndrome. The nurse expects which findings in the cerebral spinal fluid (CSF) analysis?

Normal glucose level Glucose levels are decreased in many bacterial infections as the bacteria "eat" the glucose found. GB is unique in that there may be normal glucose levels found in the CSF. Clear cerebral spinal fluid Cloudy CSF is expected in the case of bacterial meningitis. Elevated protein concentration Protein is elevated due to inflammation and will be seen in the CSF of a patient with Guillain-Barré syndrome. Normal white blood cell level (WBC) White blood cell levels are not affected by Guillain-Barré syndrome. This differs from other infections where elevated white blood cell levels can be seen.

Children with Duchenne Muscular Dystrophy show all of the following except

Normal muscle tone

The nurse is working with a new graduate in developing a plan of care for a newborn infant with spina bifida (myelomeningocele) and hydrocephalus. The nurse reminds the graduate to monitor for increased intracranial pressure (ICP). Which assessment technique should be performed to detect the presence of an increase in ICP?

Observe anterior fontanel for bulging Excessive buildup of CSF in the newborn's brain will cause expansion and fullness. The nurse can observe this through bulging (secondary to pressure) in the fontanels.

The nurse cares for a child with Guillain-Barré syndrome. The nurse notes a frequent, weak cough and decreased bilateral hand grips. What actions should the nurse take?

Obtain a pillow nurse call light for patient's use. With inadequate grip strength, and Guillain-Barré, which is progressively decreasing strength from toes working toward neck, patient needs a way to call the nurse. A pillow call light allows patient to turn the head slightly to touch pad that calls the nurse. Raise head of the bed to a semi-Fowler's position. The patient is having difficulty with oral and respiratory muscles. This will affect swallowing of saliva and diaphragmatic excursion. Placing the head of bed (HOB) up will decrease the patient's work and help prevent aspiration and hypoventilation. Do not allow patient to have anything to eat or drink. Patient is at risk for aspiration and needs to be NPO until swallowing can be further evaluated. Explain to patient what was assessed and the meaning. The patient should usually be told what is going on and what health care provider is doing. Patient's Guillain-Barré is progressing as evidenced by decreased strength in hands and inability to forcefully cough. Patient may soon require intubation and should be aware of that.

An eight-year-old child is brought to the emergency department by his parents with signs of late hydrocephalus. The nurse manages what expected findings in this patient?

Ongoing seizure activity Seizures occur in a child with late hydrocephalus due to brain stress from excess fluid. The nurse administers benzodiazepines. Blood pressure 140/90 mm Hg An increased blood pressure will be exhibited in patient with late hydrocephalus. If parents desire more than comfort care, nurse may give medications to decrease blood pressure. Heart rate of 45 beats per minute A child with late hydrocephalus will exhibit decreased heart rate. If parents desire more than comfort care, nurse may give medications as ordered to increase heart rate.

The nurse is caring for an eight-year-old child undergoing a lumbar puncture. What actions should the nurse take?

Position the child to control movement. It is essential that the child remain in a controlled position to allow correct spinal needle insertion and minimize side effects and adverse events. Encourage the child to take deep breaths. Taking deep breaths is a well-known, easy to implement pain and anxiety-reduction strategy that also prevents the child from holding his or her breath while experiencing pain. Explain to the child what to expect during the procedure. Children cooperate better when they know what to expect and understand what is happening to them.

The nurse classifies the eight-month-old patient as having a severe injury based on what findings?

Opens eyes to pain, motor extension, and moans to pain This exhibits a higher score on the modified Glasgow coma scale that is used by the nurse to determine severity of head injury.

Match the bone with the appropriate classification: Sesamoid bones

Patella

The eleven-year-old patient is admitted with an incomplete spinal cord injury at C4. Which findings cause the nurse the most concern?

Patient reports difficulty taking a deep breath. A cervical injury affects the ability to control abdominal muscles and other muscles in the thorax, such as the diaphragm which helps to control depth of purposeful inspiration. This could be a sign that the spinal cord injury is actually complete, has progressed, or that there is additional damage to the spinal cord. The patient may require intubation as progression continues. Patient's blood pressure increases to 150/92 mm Hg. Autonomic dysreflexia is characterized by a sudden rise in blood pressure and will need to be a priority in caring for this patient to prevent intracranial hemorrhage, seizures, and heart attack. Patient has "goose bumps," small raised bumps on the skin. Typically associated with being cold, these raised papillae could indicate that the patient is experiencing hypothermia or autonomic dysreflexia and intervention is needed quickly.

The hospitalized child with spina bifida has broken out in a rash. What actions should the nurse take?

Place a precautions sign on the door and in the room. There is likely a latex allergy. A sign indicating the patient is allergic to latex is needed on the door and above the bed to alert other health care workers. Additionally, at a minimum, it should be listed on the patient's armband. The next exposure could induce anaphylaxis. Change out the gloves in the room and outside the door. Children with spina bifida are at high risk for developing latex allergies due to chronic illness resulting in increased exposure to latex-containing products over time. If latex-containing gloves are in the room, they must be removed until it can be determined definitely whether this rash is related to latex. Request that the health care provider prescribe a steroid. A steroid and/or antihistamine will calm the immune reaction to the latex. Check the patient's vital signs for a temperature elevation. This rash could be related to a virus instead of latex. The nurse should begin to rule that out by assessing the patient for a fever.

Match the cerebral palsy (CP) symptoms to the nursing intervention for the hospitalized pediatric patient: Loss of coordination

Place bed in lowest position

A child is diagnosed with early stage hydrocephalus. What actions should the nurse perform?

Place padding on all four of bed rails. Although seizures are a late sign, any time intracranial pressure (ICP) is increased enough to be symptomatic, seizure precautions should be instituted to protect patient. Administer ondansetron (Zofran) for vomiting. Vomiting occurs due to pressure within the brain on structures that control vomiting, however the action of vomiting increases ICP. The nurse should make every attempt to reduce actions that increase ICP. Provide orientation to the room, call light, and personnel. The child may exhibit confusion, and providing orientation may reduce the severity of the confusion. Consult dietician for dietary supplement recommendations. An infant with early stage hydrocephalus will present with poor feeding, and therefore the nurse may notice the child is not gaining weight.

While assisting with a lumbar puncture, the nurse places the highest priority on monitoring which physiologic parameters?

Pulse rate The pulse rate of the child needs to be monitored by the nurse during a lumbar puncture. A rapidly increasing or decreasing heart rate indicates a problem that needs to be addressed immediately. Pulse oximetry Part of continually assessing the patient's cardiorespiratory status is ensuring that the respiratory rate is providing adequate oxygenation while the child's torso is in a position that restricts expansion of the thorax. Respiratory rate The positioning required during a lumbar puncture constricts normal lung movement, air intake, and the ability of the nurse to visualize that the patient is breathing adequately so monitoring respiratory rate is a priority.

A child is brought to the emergency department following a motor vehicle accident and a Glasgow coma score (GCS) is obtained with the following results: Opens eyes spontaneously and obeys motor commands but seems confused. Which should be an appropriate step in nursing management of this patient?

Reassess neurologic status within thirty minutes. The nurse should continue to monitor the patient since the child is showing signs of a mild head injury.

Which statement explains how cerebral spinal fluid (CSF) maintains homeostasis?

Removes wastes from the brain The CSF functions to maintain homeostasis by removing wastes from the brain because as it flows through the cranial vault and vertebral column it collects wastes and returns them to the venous system.

A child presents to the emergency department with sudden bilateral ascending weakness and is diagnosed with Guillain-Barré syndrome. What should the nurse most closely monitor?

Respiratory status Along with achieving optimal neurologic function, the nurse should prioritize monitoring the respiratory rate in a child with bilateral ascending weakness.

Match the bone with the appropriate classification: Flat bones

Ribs

Match the meningeal layers and structures with the appropriate description: Tentorium

Separates cerebrum from cerebellum

Match each component of the musculoskeletal system with the connecting tissue that helps it to function: Articular cartilage

Shock absorbing structure

The nurse is caring for a 7-year-old child with a suspected left radius/ulna fracture who presents to the pediatric emergency room. The nurse notes a painful, bruised, edematous area on the left lower arm, but the assessment is otherwise normal. Which provider orders would the nurse anticipate?

Single view radiograph of the left arm A single view radiography would be an order the nurse would anticipate. Assess pain level every 1 hour and as needed The child reports pain at the injured site, therefore, the nurse should anticipate an order to assess pain level in the child.

An infant is being evaluated for bacterial meningitis. The nurse holds the patient in which position for the sampling of cerebrospinal fluid (CSF)?

Sitting Having the child in a sitting position will provide adequate flexion of the lumbar spine for performing a lumbar puncture. Side-lying The side-lying position provides adequate flexion of the lumbar spine for performing a lumbar puncture.

The twelve-year-old patient with spina bifida exhibits learning delays. What other assessment findings does the nurse anticipate?

Slow to follow directions If the child's spine is affected high enough to result in learning delays, additional processing delays, such as following directions, might be expected. Difficulty swallowing foods The child's cognitive delays are related to the height of the neural tube defect, however difficulty swallowing may occur and can also indicate the child also has Chiari II malformation. Upper limb discoordination The child with learning delays secondary to spina bifida will also have difficulty with gross and fine motor skills using the arms and hands. Bowel and bladder incontinence Even fairly low neural tube defects can result in incontinence. A defect as high as this one definitely leads the nurse to anticipate incontinence.

A child who plays soccer is brought to the clinic by the mom who suggests her child is not acting right. Which associated finding does the nurse evaluate further?

The child cannot recall yesterday's events. Memory loss can be associated with postconcussion syndrome, and therefore the patient may have difficulty remembering yesterday's events. This information helps the nurse direct further care.

The health care provider examines a 7-year-old child, revealing increased deep tendon reflexes, hypertonia, flexion, and a scissors gait. Which intervention does the nurse include in this patient's plan of care?

Teach the child and parents how to monitor for and address learning difficulties. Children with cerebral palsy tend to have learning disabilities and poor attention spans. Educating parents on how to seek help for these problems as they arise is an essential part of this child's care plan.

A twelve-year-old child's spina bifida lesion affects the upper lumbar vertebrae. The nurse evaluates that the child is meeting therapeutic goals when the child demonstrates which behaviors?

The child participates in exercise activities daily. Increasing the child's mobility is a goal in the care of a child with spina bifida, and therefore the child's continued ability to participate in daily exercise indicates the goals of care are being met. The child has successful attempts at bladder emptying. A child with spina bifida must be placed in a bladder-emptying program, and therefore successful attempts at emptying the bladder is an indicator that goals are being achieved. The child bathes, dresses, and puts on shoes without help. This is an appropriate act of independence and demonstrates the child is maintaining mobility and is actively working toward therapeutic goals.

The nurse evaluates a three-year-old child for developmental delays. When the nurse notes that the child has difficulty maintaining balance while walking, what other assessments does the nurse perform?

The nurse assesses overall muscle tone and strength. Cerebral palsy (CP) is characterized by abnormal muscle tone and therefore the nurse will assess the overall tone and strength at this time. The nurse assesses for speech impairments and delays. Impaired speech is a characteristic developmental impairment found in CP and therefore this would be assessed at this time. The nurse assesses deep tendon and primitive reflexes. A child with CP may have persistent primitive reflexes, which should have disappeared in infancy. In assessing a suspected neurologic disorder, the nurse should assess deep tendon reflexes as well. The nurse assesses for developmental milestone variances. The child with cerebral palsy may not have reached other milestones at appropriate ages, and therefore should be assessed for these at this time.

An arterial blood gas is drawn on a patient and it shows a decrease in the arterial partial pressure of carbon dioxide (PaCO2). The nurse should expect which response of the cerebral vasculature?

Vasoconstriction, decreased blood flow A decrease in the partial pressure of carbon dioxide will result in vasoconstriction and a decrease in cerebral flood flow.

Match the bone with the appropriate classification: Irregular bones

Vertebrae

Which is true of febrile seizures?

They reoccur in 1/3 of cases

What anatomical features of pediatric bone reduce the risk of fracture compared to adults?

Thick periosteum Children have an increased thickness of the periosteum compared to adults. This provides additional protection against fracture. Epiphyseal (growth) plate The epiphyseal (growth) plate is not sealed in the child. It still contains hyaline cartilage, which acts as a shock absorber. Increased cartilage to bone ratio There is an increased cartilage to bone ratio in pediatric bone. The bone is more flexible and therefore less likely to fracture.

True or False Folic acid has helped reduce the incidence of neural tube defects.

True

Match the meningeal layers and structures with the appropriate description: Pia

Vascular, transparent membrane